I was scheduled to present the health-care plan to a joint session of Congress on September 22. I was feeling upbeat. That morning I had signed the bill creating AmeriCorps, the national service program; it was one of my most important personal priorities. I also nominated Eli Segal, who had shepherded the bill through Congress, to be the first chief executive of the Corporation for National Service. Attendees at the signing ceremony on the back lawn of the White House included young people who had answered my call to do community service that summer; two old veterans of FDR’s Civilian Conservation Corps, whose projects still marked the American landscape; and Sargent Shriver, the first director of the Peace Corps. Thoughtfully, Sarge had lent me one of the pens President Kennedy had used thirty-two years earlier to sign the Peace Corps legislation, and I used it to bring AmeriCorps into being. Over the next five years, nearly 200,000 young Americans would join the ranks of AmeriCorps, a larger number than had served in the entire forty-year history of the Peace Corps.
On the evening of the twenty-second, I felt confident as I walked down the aisle of the House Chamber and looked up at Hillary sitting in the balcony with two of America’s most famous doctors, the pediatrician Dr. T. Berry Brazelton, a longtime friend of hers, and Dr. C. Everett Koop, who had served as President Reagan’s surgeon general, a position he used to educate the nation about AIDS and the importance of preventing its spread. Both Brazelton and Koop were advocates of health-care reform who would lend credibility to our efforts.
My confidence slipped when I glanced at the TelePrompTer to begin my speech. It wasn’t there. Instead, I was looking at the beginning of the speech to Congress on the economic plan that I’d delivered in February. The budget had been enacted more than a month earlier; Congress didn’t need to hear that speech again. I turned to Al Gore, who was sitting in his customary seat behind me, explained the problem, and asked him to get George Stephanopoulos to fix it. Meanwhile I started the speech. I had a written copy with me and I knew what I wanted to say anyway, so I wasn’t too worried, though it was a bit distracting to see all those irrelevant words scrolling by on the TelePrompTer. At the seven-minute mark, the right text finally came up. I don’t think anyone knew the difference at the time, but it was reassuring to get my crutch back.
As simply and directly as I could, I explained the problem—that our system cost too much and covered too few—and outlined the basic principles of our plan: security, simplicity, savings, choice, quality, and responsibility. Everyone would have coverage, through private insurers, that would not be lost when there was an illness or a job change; there would be far less paperwork because of a uniform minimumbenefit package; we would reap large savings through lower administrative costs, which were then significantly higher than those of other wealthy nations, and a crackdown on fraud and abuse. According to Dr. Koop, that could save tens of billions of dollars.
Under our plan, Americans would be able to choose their own health plan and keep their own doctors, choices that were vanishing for more and more Americans whose insurance was carried by health maintenance organizations (HMOs), which tried to hold down costs by restricting patient choices and conducting extensive reviews before approving expensive treatments. Quality would be assured by the issuance of report cards on health-care plans to consumers, and the provision of more information to doctors. Responsibility would be enforced across the board against health insurance companies that wrongfully denied care, providers who padded their bills, drug companies that overcharged, lawyers who brought bogus suits, and citizens whose irresponsible choices weakened their health and exploded costs to everyone else.
I proposed that all employers provide health insurance, as 75 percent of them were already doing, with a discount for small-business owners who otherwise couldn’t afford the insurance. The subsidy would be paid for by an increase in cigarette taxes. Self-employed people would be able to deduct all the costs of their health-care premiums from their taxable incomes.
